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Postpartum depression : who gets help? : results from the Colorado, New York, and North Carolina PRAMS Surveys

State Center for Health Statistics Statistical Brief No. 24 – June 2002
Postpartum Depression: Who Gets Help?
Results from the Colorado, New York, and North Carolina PRAMS Surveys
1997- 1999
by Harry Herrick
Statistical Brief No. 24
North Carolina
Department of Health and Human Services
Division of Public Health
State Center for Health Statistics June 2002
Statistical
Brief
www. schs. state. nc. us/ SCHS/
Introduction
Previous studies estimate that about 10 to 15 percent of
mothers suffer from postpartum depression, yet for many
of these mothers their depression remains unrecognized and
untreated. 1- 3 The few studies that have examined help-seeking
among mothers with postpartum depression show
that the majority of these mothers do not seek help from any
source and only about 20 percent consult a health
professional. 4 The reluctance of mothers to acknowledge
their emotional difficulties after childbirth, or mistaken
beliefs about the cause of their depression, are some of the
reasons why many mothers choose not to seek help. 5- 6
Little is known about the characteristics of mothers who
seek help for postpartum depression ( PPD). To help bridge
this gap in our understanding, this study uses survey data
obtained from 14,860 randomly selected live births from
three states: Colorado, New York ( excluding New York
City), and North Carolina.
We describe the prevalence of PPD and help- seeking among
selected demographic groups. We explore the extent to
which help- seeking is related to ( 1) support for the mother
and her baby, ( 2) a difficult or anxious time during
pregnancy, and ( 3) access to private medical care. We
anticipated that the rate of help- seeking would be higher
among mothers with higher levels of support, among
mothers with psychological distress beginning in pregnancy,
and among mothers who received prenatal and postnatal
care from a private physician. 7- 9
Methods
The sample was obtained from the Pregnancy Risk
Assessment Monitoring System ( PRAMS). PRAMS is a
state- based survey of mothers with a recent birth. Funded
by the Centers for Disease Control and Prevention ( CDC),
the PRAMS data collection protocol ( mail with telephone
follow- up) and sampling methodologies are standardized so
that survey data may be aggregated across states. Colorado
and North Carolina initiated PRAMS in 1997, New York
in 1996. All three states elected to measure postpartum
depression in the survey. By combining PRAMS data from
these states over a three- year period ( four years for New
York), we had a sufficiently large sample for conducting an
analysis of help- seeking among mothers who reported being
depressed after birth.
In PRAMS, postpartum depression is measured on a five-point
scale ranging from “ not at all depressed” to “ very
depressed and had to get help.” The PPD study group
consisted of mothers who reported being very depressed or
very depressed and got help. The latter group defined the
subset of help- seekers.
Three study factors were examined. Measures of support
included prenatal support ( i. e., partner wanted the
pregnancy) and postnatal support ( i. e., mother had someone
to talk to about her problems after delivery and someone
to help care for the new baby). Early psychological distress
was defined as mothers with PPD who also reported that
the time during their pregnancy was “ a very hard time” or
“ one of the worst times of my life.” Use of private medical
care was defined as mothers who reported having most of
their prenatal or well- baby visits in a private physician’s
office.
The results are presented in Tables 1 and 2. For each of the
study variables we show the total percentage of mothers who
were very depressed and the percentage of these mothers
who got help for their depression. These percentages are
weighted to represent the states’ annual birth populations.
In both tables, we tested for significant differences in the
percentages of mothers with PPD and the percentages of
those who got help, with the lowest level of the indicator
serving as the reference group. All study results were
analyzed with the SUDAAN software, intended for the
analysis of complex survey designs.

State Center for Health Statistics Statistical Brief No. 24 – June 2002
Postpartum Depression: Who Gets Help?
Results from the Colorado, New York, and North Carolina PRAMS Surveys
1997- 1999
by Harry Herrick
Statistical Brief No. 24
North Carolina
Department of Health and Human Services
Division of Public Health
State Center for Health Statistics June 2002
Statistical
Brief
www. schs. state. nc. us/ SCHS/
Introduction
Previous studies estimate that about 10 to 15 percent of
mothers suffer from postpartum depression, yet for many
of these mothers their depression remains unrecognized and
untreated. 1- 3 The few studies that have examined help-seeking
among mothers with postpartum depression show
that the majority of these mothers do not seek help from any
source and only about 20 percent consult a health
professional. 4 The reluctance of mothers to acknowledge
their emotional difficulties after childbirth, or mistaken
beliefs about the cause of their depression, are some of the
reasons why many mothers choose not to seek help. 5- 6
Little is known about the characteristics of mothers who
seek help for postpartum depression ( PPD). To help bridge
this gap in our understanding, this study uses survey data
obtained from 14,860 randomly selected live births from
three states: Colorado, New York ( excluding New York
City), and North Carolina.
We describe the prevalence of PPD and help- seeking among
selected demographic groups. We explore the extent to
which help- seeking is related to ( 1) support for the mother
and her baby, ( 2) a difficult or anxious time during
pregnancy, and ( 3) access to private medical care. We
anticipated that the rate of help- seeking would be higher
among mothers with higher levels of support, among
mothers with psychological distress beginning in pregnancy,
and among mothers who received prenatal and postnatal
care from a private physician. 7- 9
Methods
The sample was obtained from the Pregnancy Risk
Assessment Monitoring System ( PRAMS). PRAMS is a
state- based survey of mothers with a recent birth. Funded
by the Centers for Disease Control and Prevention ( CDC),
the PRAMS data collection protocol ( mail with telephone
follow- up) and sampling methodologies are standardized so
that survey data may be aggregated across states. Colorado
and North Carolina initiated PRAMS in 1997, New York
in 1996. All three states elected to measure postpartum
depression in the survey. By combining PRAMS data from
these states over a three- year period ( four years for New
York), we had a sufficiently large sample for conducting an
analysis of help- seeking among mothers who reported being
depressed after birth.
In PRAMS, postpartum depression is measured on a five-point
scale ranging from “ not at all depressed” to “ very
depressed and had to get help.” The PPD study group
consisted of mothers who reported being very depressed or
very depressed and got help. The latter group defined the
subset of help- seekers.
Three study factors were examined. Measures of support
included prenatal support ( i. e., partner wanted the
pregnancy) and postnatal support ( i. e., mother had someone
to talk to about her problems after delivery and someone
to help care for the new baby). Early psychological distress
was defined as mothers with PPD who also reported that
the time during their pregnancy was “ a very hard time” or
“ one of the worst times of my life.” Use of private medical
care was defined as mothers who reported having most of
their prenatal or well- baby visits in a private physician’s
office.
The results are presented in Tables 1 and 2. For each of the
study variables we show the total percentage of mothers who
were very depressed and the percentage of these mothers
who got help for their depression. These percentages are
weighted to represent the states’ annual birth populations.
In both tables, we tested for significant differences in the
percentages of mothers with PPD and the percentages of
those who got help, with the lowest level of the indicator
serving as the reference group. All study results were
analyzed with the SUDAAN software, intended for the
analysis of complex survey designs.